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DateLine Sunday, 11 November 2007

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Diabetes : the silent scourge

World diabetes Day-November 14:

by Shanika Sriyananda

"Eat natural ... stay active... be content..." would be the frequently murmured mantra among the youth very soon to escape the agony of being 'Diabetic' throughout their lives.

Diabetes is 2,500 years-old and people around the world know enough about this illness. In most of the countries which known as diabetes 'hot spots', the cases of diabetes have increased by manyfold compared to the situation a decade ago.

I can still remember uncle Bernie, my favourite neighbour, who was still strong and active to his age, later became lean day by day.

Though he knew about this condition where the glucose tolerance rate has been abnormal due to impaired insulin activity, Uncle Bernie never thought he would fall into that segment of patients.

However, with the family doctor's diagnosis that uncle Bernie was compelled to say 'No' to most of his favourite dishes. Recovering from a diabetes coma, surveying a narrow escape, thanks to uncle Bernie's wife he has been given extra care now.

Uncle Bernie is not alone in this struggle. The number of diabetics keep on increasing annually and the most important factor now is that it is becoming an illness among the younger generation. And also it is not an illness of the riches but an illness among the poor.

Dr. Mahen Wijesuriya, Director of the National Diabetes Centre told a recent media conference that diabetes is not a problem of an individual, not a joke or a problem of the next door person but a problem of each and every one today. "There is no caste, creed or religion to this illness. All are equally attacked", he said.

Believe it, the gravity of the illness is becoming worst by every minute with our 4.5 million Sri Lankans suffering from this single illness - Diabetes, today.

"Mata Seeni" (I have sugar) is the most common complaint that we hear from many people. And the most important factor that shows the gravity of the illness is that six persons die of diabetes, every minute.

"Diabetes is the leading cause of eye ailments and 10 to 20 percent people around the world die due to kidney failure caused by diabetes. Over 50 percent of heart attacks and strokes are due to diabetes and this is a main cause for one million amputations every year", he said.


Be active avoid diabetes

Apart from the genetic and foetal origin, two major factors, according to health experts contribute to the alarming rise in diabetes: poor diet and lack of exercise. The stress is also another main factor which aggravates the illness.

The attitudes of the present generation who are hooked to fast food than the traditional balanced diet that causes a rapid increase in blood sugar.

The healthy traditional food items with less oil and carbohydrates have been overlooked with sweets, French fries, potato chips and lots of mouth watering fast food items full of oil. According to Dr. Wijesuriya, the illness has spread its wings from the city to rural areas where a lots of poor people are now more prone to diabetes.

What is insulin?

It is a hormone that is needed to convert sugar, starch and other food into energy needed, for daily life. Without insulin your body cannot get the energy it needs from your food. This hormone is made by a gland in the body called the pancreas.

Most of our food intake is turned into glucose, a form of sugar which our body uses for energy. Insulin helps the glucose get into the cells of the body to provide energy.

Types of diabetes:

There are two main types of diabetes.

Type 1 : This is called insulin-dependent diabetes (IDDM). Patients require insulin for survival and this occurs when very little or no insulin is produced. It develops most often in children and young adults and is also found in adults. The onset is usually sudden and dramatic.

This accounts for about 10 per cent of all diabetes in the country.

Type 2: This is called non-insulin dependent diabetes. Patients do not generally require insulin in administration for survival. This occurs when the body is unable to produce sufficient insulin to meet its requirements or it cannot utilize the insulin that is produced effectively. Type 2 diabetes can be controlled through diet, routine exercise and oral medication.

This, which is recorded among adults is becoming common in young people, including children and teens. The onset is gradual and therefore hard to detect and accounts for about 90 per cent of the total diabetes population.

What is diabetes mellitus?

It is a chronic condition that arises when pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces which leads to raised blood glucose levels.

What are the types?

Type 1/Insulin Dependent: Childhood onset and they produce very little or no insulin - Insulin deficiency

Type 2/Non Insulin Dependent: Adult onset and they cannot use insulin effectively that has been produced in body - Insulin resistance

Gestational Diabetes Mellitus (GDM): Pregnancy induced state of insulin resistance.


Balance diet a wayout

Who are at risk?

Family history of diabetes

Physical Inactivity

Unhealthy diet

Stress (Occupation/financial/educational/nutritional or illness)

Overweight or obese

History of GDM

What are the symptoms?

Increased thirst and dry mouth

Frequent urination

Constant hunger

Sudden weight loss

Extreme tiredness or lack of energy

Delayed wound healing

Recurrent infections

Blurred vision

Is there a cure?

NOT - only control and prevention

What are the complications?

Heart disease/stroke

Kidney disease

Blindness

Sensory impairment

Amputations

Prevention of diabetes

1.Modifying the risk factors of people (Primary prevention)

2.Treating and effectively diagnosed diabetics to prevent development of complication (Secondary prevention)

3.Preventing further deterioration of complications and rehabilitating disabled due to complications (Tertiary prevention)

How to achieve? Primary prevention

1.General population (General public, health care professionals and policy makers)

Education

Awareness

Advocacy

2. High risk

Family history

Physical inactivity

Increased waist

Increased BMI

Secondary prevention

Early detection

Correct guidance and treatment

Good compliance: responsibility with patient/family/doctor/policy maker

Regular monitoring/complication detection

Tertiary prevention

Correct management of life threatening complications:

Heart/Kidney/Eye/Limb/Brain

Availability of medications/Complications assessment/Intensive care and follow up

Availability of other specialised care/rehabilitation teams.

Children and adolescence

More and more children are at risk in the world as a result of dietary changes, lack of physical activities.

One in ten children in the world is over weight.

22 million of them are under 5 years of age.

85% of children with Type 2 diabetes are over weight or obese.

African, Hispanic, Asian and Native American children are more at risk.

Type 1 is also rising at an alarming rate of 3% a year. 70,000 children a year develop

Type 1 diabetes annually.

****

How is it diagnosed?

Fasting Blood Sugar test (mg/dl)

<100 Normal

100-125 At risk of diabetes

>126 Diabetes

Post Prandial Blood Sugar Test (mg/dl)

<140 Normal

140-199 At risk of diabetes

>200 Diabetes

***

Global prevalence rate of diabetes

Global pandemic

2006 - 246 million

2025 - 380 million

In 2025, 80% of them will be in low and middle income countries (Sri Lanka is one of them)

Type 2 diabetes accounts for 90% of the all the diabetics

50% with the disease are unaware of condition

3.2 million people die every year of diabetes related illness globally (More than HIV/AIDS - 3 million)

2.5% million diabetics become blind - commonest cause

****

Prevalence rate of diabetes in Sri Lanka

Year		Prevalence (Islandwide)	  Urban	        Rural
1990		2.5%			   5		  2
2000		6.5%		           7.7	         12
2007		10.2%			   16		8.6

****

Guide to find the ideal body weight for height (BMI-23)

Height			Maximum		Height	       Maximum
(Feet,			Weight		(Feet,	        Weight
Inches)			(kg)		Inches)	        (Kg)
4’5”			41.01		5’6”	         64.6
4’6”			42.57		5’7”	         65.54
4’7”			44.16		5’8”	         67.51
4’8”			45.78		5’9”	         69.51
4’9”			47.43		5’10”	         71.54
4’10”			49.11		5’11”	         73.6
4’11”			50.82		6	       	 75.68
5			52.56		6’1”	         77.8
5’1”			54.32		6’2”	         79.95
5’2”			56.12		6’3”	         82.12
5’3”			57.95		6’4”	         84.33
5’4”			59.8		6’5”	         85.56
5’5”			61.68		6’6”	         88.82

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